The Relative Value Scale Update Committee provides recommendations to CMS on relative value units for specific procedures and services
Nov. 20, 2020 (ACP) – Now is the time for selected internists to respond to the new Relative Value Scale Update Committee (RUC) survey and help establish and ensure fair compensation for commonly performed procedures and services.
The RUC survey goes out to all specialists, but primary care specialist feedback is increasingly important due to the time and attention they devote to certain services, said Brian Outland, ACP director of regulatory affairs. ACP asks randomly chosen members to complete each survey.
What Is the RUC and Why Does It Matter?
When Medicare transitioned to a physician payment system based on the Resource-Based Relative Value Scale (RBRVS) in 1992, the American Medical Association (AMA) formed the RUC, a multispecialty committee that provides recommendations to the Centers for Medicare & Medicaid Services (CMS) about how to value a physician's work based on the time and complexity involved in performing a given procedure or service.
The RUC includes a volunteer group of 31 physicians and 300 medical advisors who represent each specialty. Dr. M. Douglas Leahy is the ACP RUC representative. He also sits on the ACP Coding and Payment Policy Subcommittee, which reports to the ACP Medical Practice and Quality Committee.
The RUC reviews thousands of individual medical services to determine whether they are appropriate, undervalued or overvalued. The AMA then assigns a specific relative value unit (RVU) for the current procedural terminology (CPT) code assigned to each service or procedure based on data from these surveys. This RVU is multiplied by a set dollar figure or conversion factor to determine the price at which Medicare reimburses practitioners for the procedure. These recommendations are then sent to CMS for a final decision.
“CMS takes about 90% of recommendations that come through the RUC, and private insurers tend to follow CMS,” Outland said. “The RUC is the only way to get robust data and invaluable information to CMS about physician services.”
CMS publishes the annual update to the Medicare RBRVS in the Federal Register every year at around the same time that the AMA publishes the new CPT code book for the coming year. The updated CPT codes and relative values go into effect on Jan. 1 of each year.
RUC Survey Significance
In general, the RUC survey seeks to determine how much time it takes for a physician to perform a service, including mental effort, judgment, skill and physical effort. The survey also takes into account physician stress that may occur if an adverse outcome has serious consequences.
The survey goes out to many types of specialists, but primary care specialist input is essential. “There are other specialties that are not internists who might perform the same service, but just not as often or as rigorously as internists, so the information they provide may not be as accurate as the information provided by internists, who perform these services all the time,” Outland explained.
For example, primary care specialists often provide evaluation/management (E/M) services for patients, and these services can be much more involved and time-intensive than the same services performed by proceduralists. “An internist has to think about all of a patient's comorbidities and health conditions as a whole, and it can take longer to develop a plan,” Outland said. By contrast, the components and variables involved in an E/M service may be markedly different for a proceduralist.
Chronic care management is another area where it is important to get internist feedback on the time and complexity required, Outland said. “If more proceduralists than internists respond to the RUC survey, the RVU could be inaccurate because they don't include the time and intensity that internists put in relative to a specific service,” he said.